8 year old girl s/p fall with the neck on the bath tub and developed subsequently dyspnea. After arrival of the EMS team, dyspnea became so severe that the girl had to be intubated. During the course, the girl developed a progressive soft tissue emphysema (with deflated endotracheal tube).

Pathomorphology or Pathophysiology of this disease :

N/A

Radiological findings:

CT 1: Axial neck CT in lung window: There is an extensive soft tissue emphysema, which extends from the neck to mediastinum and into the chest wall.

CT 2: Coronal reconstruction of a neck CT in lung window:Coronal reconstructed images demonstrate an extensive soft tissue emphysema, which extends from the neck to mediastinum and into the chest wall.

CT 3: Magnified view of an axial neck CT in lung window:Visible defect in the pars membranacea (arrow). Endotracheal tube is in place with extensive air in the soft tissues.

Diagnosis confirmation:

Imaging including endoscopy

Which DD would be also possible with the radiological findings:

N/A

Course / Prognosis / Frequency / Other :

Tracheal laceration is in general rare and only occurs in approximately 1% of cases with blunt thoracic trauma, because the trachea is an anatomically well protected structure. Problematic is the often delayed diagnosis because of subtle and unspecific findings and also because in case of polytrauma the attention to other more obvious inhjuries (1,2). Computed tomography allows a detailed depiction of air collections and often of the tracheal defect, as in this case. Chen et al. could show the defect in 70% of cases (3). This is especially helpful in therapeutic planning, because in a clinically stable patient with small lacerations, a conservative approcach still leads to good results (1,2). In a review of the literature 15 cases were reported by Claes et al.: all children survived a small tracheal rupture after blunt trauma and only in one patient hoarseness persisted (2).